The presence of an impaired physician in a health care setting is perceived as a huge challenge with adverse implications. The impaired doctor, the institution he works for, his profession, his clients and the society in general are impacted. The ramifications of this challenge as identified by the participants include financial, social, clinical and medico-legal consequences.
4.3.1 Harm to self and family
Many respondents noted the potential harm that can befall a practicing impaired physician and his family. Prominent among these were medical negligence and malpractice, as well as job loss and associated financial consequences. Disciplinary issues, harm to the family and reputational damage to self are other problems the impaired doctor has to contend with.
‘We are also in a risky profession because there is litigation for medical negligence and malpractice. It destroys you as a person...you blame yourself for the rest of your life...for being negligent or killing someone...it can negatively impact your career...it will involve disciplinary action by HPCSA. It might have implications for your family, because if you lose your job and you happen to be the breadwinner or even if you are not the breadwinner...I mean having an income to sustain you and your family is quite important. So if you lose that the future of your family and your reputation is at stake’.
(Interview 5)
‘They get a lawyer; they file a suit against the hospital. It tarnishes the doctor’s image and the worst thing it goes on the internet...all cases that have been charged. There is a legal record of it. If you Google the doctor’s name it comes up as ‘he was accused of whatever’ on the internet. It is terrible’. (Interview 8)
‘If we are impaired one way or another, our capacity to make accurate and conscious decisions become jeopardized, for instance, tasks like the taking of blood for investigation will require the doctor to apply the universal precaution rules. However, an impaired physician is at an increased risk of injury or contracting an infectious disease during such procedure because needle-stuck injury can easily occur since
such an impairment may make him to be unable to take adequate precaution to stay safe...’. (Interview 10)
4.3.2 Harm to the medical profession
Three participants noted the significant social harm that may accrue to the medical profession because of the activities of an impaired doctor. The occurrence of few medical mishaps unfortunately get publicised in the media resulting in a huge reputational damage to the medical profession.
‘The actions of an individual may well hamper the perception of the profession as a whole. If an impaired doctor engages in and jeopardizes the safety of his patient resulting in the loss of life, these things often reach the media and the medical practitioners in the same area will be surrounded by the negative impact of that activity because it is often publicised'. (Interview 10)
‘I know recently there were lots of incidents where doctors were physically and sexually abusing patients...we read about it in the media...they gave the profession a bad name'. (Interview 7)
‘Everybody noticed...even the patients now started talking that...that person is not Ok.
They were even calling to say they think the doctor is not fine. One morning he came very late to work, very drunk, he couldn’t even stand... very disgraceful!!’ (Interview 6) 4.3.3 Harm to the employing healthcare Institution
Many respondents noted an association between having a working impaired doctor in the workplace and the occurrence of certain unpleasant consequences. The notable problems the healthcare facility must face up to include litigation and financial losses, reputational damage, safety and security concerns. In addition, the institution must contend with problems such as service disruptions resulting from interpersonal problems and conflicts that breed anger and frustration in work colleagues, clinical governance issues, and reduced work output.
‘They come late to work, they abuse sick leave and call in sick a lot of times making the whole place dysfunctional and difficult to manage’. (Interview 2)
‘You get a doctor who is abusing substance, a doctor who is not seeing adequate number of patients or not assessing his patients according to policies and guidelines...not assessing patients properly or fully, ...might have negative incidents and might have medico- legal consequences for the institution. This doctor may also have frequent absences from work. Frequently absent himself from work point, may appear intoxicated or under the influence of drugs at work. These doctors have squabbles and discord with colleagues and even patients. Patients and workers feel unsafe and insecure; this way the department is not able to achieve its goal’.
(Interview 3)
‘suddenly we see this change and they come in late, they are not dressing appropriately.... they are not speaking to people appropriately or they come to work intoxicated, they refuse to see patients, they get into arguments unnecessarily with patients, nurses and colleagues’. (Interview 4)
‘He comes in late all the time, he is not able to function well and just sitting down...he is supposed to be seeing patients and he’s not doing that... We had someone that was always drinking... comes to work drunk to the extent that the patient now like...call somebody and say... is the doctor alright? Because the doctor is sleeping and he’s got the smell of alcohol, he is not steady, he is obviously drunk. The doctor shouts at the patients and everybody around, even the patient is afraid to go into the consulting room. People like him can pose a danger to patients’. (Interview 6)
4.3.4 Harm to patients
Four participants expressed a lot of negativity with regards to having an impaired doctor in the workplace. They were of the view that patients using such healthcare facility will be exposed to various forms of dangers and difficulties. Prominent among these are medical errors, delayed access to care and treatment. Emotional and physical abuse of patients during interaction leading to the generation of anger and frustration can also occur.
‘They talk to patients inappropriately, rudely, brazenly...and not respecting them as fellow human beings’. (Interview 9)
‘Some impaired doctors may be aggressive towards others... they shout at patients, they would not manage patient properly, and they forget to prescribe treatment’.
(Interview 8)
‘they get forgetful...commit medical errors...maybe make an improper diagnosis, write an improper prescription, mistakes can be grave and very costly resulting in the loss of life...sometimes they are irritable and they don’t handle patients well. Patients get angry and are frustrated’. (Interview 2)
‘This kind of doctor might have frequent sick leave...he may be slow in attending to the patients and he may be seeing an inadequate number of patients resulting in the delayed rendering of care to the patients'. (Interview 3)